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Table 3 Example – Context and Practice points for recommendations on advice and education

From: An innovative method for clinical practice guideline contextualisation for chronic musculoskeletal pain in the South African context

TOPIC

Strength of the evidence

Recommendation Endorsement Statements for ADVICE AND EDUCATE

 Address concerns

There is evidence

We recommend that clinicians address the patient’s concerns; and beliefs and teach the person, their family and caregivers about pain management strategies.

a Involve the family in education to enhance support. Provide relevant patient education material.

 Brief education

There is evidence

We recommend that brief education be given to patients with chronic musculoskeletal pain to facilitate continuation of work/occupation.

a Brief education can be on: examination, information, reassurance and advice to stay active.

 Advice to stay active

There is evidence

We recommend advice to stay active in addition to exercise therapy for patients with chronic low back pain to minimise long-term disability.

a Encourage occupational activities where indicated.

 Therapeutic neuroscience education

There is expert consensusb

We suggest that the clinician consider pain neuroscience education to assist the patient in understanding their condition, change their conception about pain and improve their ability to cope with pain [34]a.

a Use narratives and language that are applicable to the local context and that are culturally appropriate.

 Education about analgesia

There is evidence

We recommend that the clinician:

- educate patients about the risks and benefits of all medications and - monitor and manage side-effects.

a Use educational material for patients. Consider advice about concomitant use of over-the-counter medicines and herbal remedies.

 Source guidelines

Institute for Clinical Systems Improvement (ICSI) [35]; National Opioid Use Guideline Group (NOUGG) [36]; Scottish Intercollegiate Guidelines Network (SIGN) [37].

Criterion

 

Context and practice points

 Organisational

 

 Early education is important. Educational component can be delivered as part of a group intervention.

 Access to work sector to deliver educational strategies and material on occupational health is needed.

 Practice method (how)

 

 Verbal or written clear instructions; specific to condition

 Promotive: educational sessions at the worksite; need formal work assessment

 The educational interventions should be culturally appropriate.

 Staff (who)

 

 All treating clinicians can provide educational interventions. Work interventions require more attention/focus.

 Resources

 

 Printed educational material for patients should be available. Refer to trustworthy e-sources. Audio-visual material such as educational videos in waiting areas can be useful.

 Training

 

 The following training opportunities should be provided to enhance educational interventions: motivational interviewing skills, communication skills training, basic health promotion training. Occupational health training where needed; vocational training. May need training in pain neuroscience education.

 Timing (when)

 

 Needs to be given from an early stage of the management programme. Advise and educate at first consultation, but can be a continuous process.

 Re-assessment

 

 Assessment of recall and adherence to advice and education should take place as part of usual care at each session as appropriate. Vocational assessment should be done where indicated.

 Referral

 

 Within the interdisciplinary team

 Patient/family

 

 Explain findings of assessment to the patient using appropriate language. Patient education is important to foster adherence to treatment. Family education may enhance support. Educate patient and family about benefits of staying active and about pain neuroscience. Educate employers and colleagues at the workplace.

 Policy

 

 Healthcare 2030 [38] supports a patient-centred approach

  1. a Practice points
  2. b Recommendation nominated by the expert panel